DIEP Flaps in Women with Abdominal Scars: Complication Rates Between Different Abdominal Incisions
Andres F. Doval1, Lauren T. Daly1,2, Samuel J. Lin1, Adam Tobias1, Samandar Dowlatshahi1, Bernard T. Lee1
1Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Unversity of Massachusetts, Boston, MA, USA
Background: There are still concerns that abdominal surgery can compromise an abdominally based perforator flap in breast reconstruction. With this study, we take a closer look at the effect of prior abdominal incisions on Deep Inferior Epigastric Artery Perforator (DIEP) flap and donor site complications, with a particular focus on the different types of incisions and their influence on surgical outcomes.
Methods: A retrospective case-control study was conducted over a 6-year period. 544 consecutive DIEP flaps were divided into a control group and an incision group. A comparison between both groups was made in terms of flap and donor site complications, followed by a sub-group analysis based on the type of abdominal incision.
Results: There were no differences between groups in terms of baseline characteristics and comorbidities, however, we found a higher BMI in the incision group (p=0.01). There were no significant differences in both groups in terms of flap complications. Nonetheless, donor site dehiscence rate was found higher in the incision group (p=0.0001). In the subgroup analysis, patients with a low transverse incision had higher rates of fat necrosis (8.0% vs 23%; p=0.0001) and donor site dehiscence (9.0% vs 23% p=0.002). No differences were found between patients in the control group and those with laparoscopic incisions.
Conclusions: Results from our institution confirms that autologous breast reconstruction with a DIEP flap can be safely performed in patients who have had previous abdominal surgeries; however, patients and surgeons must be made aware of the increased risk of donor site complications. 
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